Seniors visit ER’s more frequently after nurse’s home care visit

April 30 (UPI) — Patients are more likely to visit a hospital’s emergency department after a visit from a home care nurse during the same day, even for non-urgent issues, according to research in Canada.

Researchers examined Ontario’s Hamilton-Niagara-Haldimand-Brant region, an area that includes more than 1.3 million people, 19 and older throughout 2015. Their findings were published Monday in the Canadian Medical Association Journal.

“An emergency department visit is not necessarily a negative outcome, but may be if a frail patient could more appropriately be treated by their usual community-based providers who know them best,” Dr. Andrew Costa of McMaster University in Hamilton, said in a press release.

Frail older adults visit the emergency department more often and have longer stays, more misdiagnoses and are more likely to be admitted to the hospital, researchers said.

“There have been concerns that — while striving for more efficiency — home care has evolved to be task-focused without the kind of full-scope, comprehensive practice that could be integrated with responsive primary care,” Costa said.

In their study, researchers checked the home care records to see if they visited the same day after 5 p.m.

The researchers found the likelihood of an ER visit was greater among people not admitted to a hospital or who had non-urgent scores for severity of illness. They also found that 4,429 home long-stay patients contributed 5,893 emergency department visits and 2,836 home short-stay patients contributed 3,476 visits.

Long-stay patients, who were frail older adults with multiple chronic conditions, impairments and ongoing home support needs, had a median age of 81 years. Short-stay patients, who were mainly post-acute care patients, such as wound care, intravenous medication administration or rehabilitation, had a median age of 66.

“It’s difficult to determine the appropriateness of an emergency department visit, but we found stronger associations with less acute emergency visits,” said study author Aaron Jones, a doctoral student at McMaster. “This suggests that some patients likely could have received care in less acute settings if it was available.”

Dr. Allan Detsky, a researchers at Mount Sinai Hospital and the University of Toronto, co-wrote a related commentary that was published in the journal’s issue.

“These findings are disappointing but not unexpected, and serve to remind us that patients who require home-based care are complex,” Detsky wrote. “When community-based nurses are neither integrated into primary care teams nor equipped with resources to manage patients’ problems effectively — perhaps by a limited scope of practice — patients have nowhere else to go but the emergency department.”

He said this is often associated with “failure to cope” and can prompt poor care from health care providers because of negative attitudes.

“We must all remember that social problems are real problems and that those with ‘failure to cope’ require compassionate and thoughtful care just as every other patient does — they are not impositions on our professional lives,” they wrote.

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